DIABETES & DEPRESSION: Letter from a Reader: Focusing on “The Can’ts”

In my last article, “Recognizing & Approaching Depression”, I promised to provide suggestions you could make to patients struggling with depression. I will do that in my next article. For now however, I’d like to answer an email sent to Diabetes in Control from someone I regard as sad, but not depressed.

Ann writes: “I was diagnosed with diabetes at the end of January 2004. My highest reading on the glucose tolerance test was 213. My bs reading are really good and the A1C was at 5.6 about 2 weeks ago. I feel a lot better, think clearer, find myself smiling, wake up with energy and go to bed with energy since I’ve been on a meal plan. Life is so much better. I’m so very thankful for this.

My problem is I either cry on the way to the grocery store or get really depressed while shopping. Today my mind focused on the can’t and the loss that comes with improved eating. Can’t buy lean cuisine or another quick fix meal because of the sodium, & or fat. Can’t have this and can’t have that etc. Last week I was able to focus on the cans once I began shopping. I’m normally an upbeat person and would like to shop again w/o getting depressed and crying. Just when does this end and when will I be able to move forward?”

Dear Ann: Though it certainly would be nice to know, I don’t think you’re asking for an exact time period after which your sadness will disappear. Permit me to interpret your question a bit. I suspect what you’re asking is how to stop feeling so sad and, more subtly, why you should be feeling so badly about being so good. You know the loss but you also know the gain created by healthy eating. Why doesn’t the bad feeling go away? Why is the loss so strong that, at least when you shop, it overruns the upbeat you, the you that focussed on the “cans” just the week before?

I don’t know any more about you than what’s in your email. Factors such as other physical conditions, other medications, your age, support system, general stress level, quality of relationships and spiritual status will all have some influence on your ability to be the upbeat person you normally are. Obviously, your ability to continue to stay with your healthy meal plan will also play an enormous role in keeping you stable, both physically and emotionally. Though you’re off to a great start, only time will tell us how well you will stay with a healthy lifestyle.

Assuming that none of the above are serious influences on your mood, let’s take a look at some answers to my interpretation of your questions:

1) You’re In Mourning: You’ve had several losses at one time and, like after a death, the mourning process can be powerful and is somewhat predictable. In January you lost the ability to think of yourself as healthy or perhaps “normal.” You were given a label. It pretty clearly sounds like Type 2 and since 90% of newly diagnosed Type 2 have weight as a factor and probably have Syndrome X, chances are health was a concern before your official diagnosis. That said, officially getting the word is an impactful moment and a form of loss.

You’ve lost the freedom to let your impulses govern your food choices. Indeed, you’ve lost choice.
You may be angry with yourself or fate for this loss, something we also experience in mourning death.

As you described, you’ve lost convenience and perhaps pleasure from the taste of now forbidden foods. These losses are real but are often discounted when people point out to themselves that since this convenience and pleasure isn’t good for them, thus they shouldn’t want them anymore. We do want convenience and pleasure and there’s no point in pretending otherwise. We have feelings about death and the person who died that are also often illogical and not socially acceptable, sometimes to ourselves.

Denial is a common response in mourning. I think, on a deep level, you’re still processing your new diagnosis. I regard that as normal and to be expected. Of course you “know” you have diabetes and there are times that information is well integrated. There are other times, like on the way to the market when your attention is directed towards food, that the denial emerges. For illustration, ask yourself if you feel the same sense of “can’t” in regard to anything to which you are allergic. You are likely to be aware of restrictions re allergies but the emotional response will be much less intense.

The “normal” mourning process waxes and wanes. People are initially pained, many things trigger the pain via association and over time the triggers are fewer and the responses less painful.

2) You’ve done very well. You have moved forward. Not forward in the sense of no longer feeling the
“can’ts”, forward in having an A1c of 5.6, of feeling as good as you do and of going shopping last week and being “can” focussed. Perhaps doing well is part of a deeper wish/expectation /fantasy that after being diagnosed you would do what should be done and then things would be OK again, back to “normal.” Restricting your choices in the supermarket shatters that fantasy.

3) Restriction of choice and loss of things we like are universal and common experiences. However, the exact history of these things in each person’s life is different. It’s always uncomfortable but for some the pain can run deep. If your life contains particularly painful experience around restriction and loss, your present response is going to be enhanced.

4) Life outside of food effects life with food. If you’re having a day in which life is filled with joy and promise, chances are the supermarket will be filled with “can”. If the reverse is true, you are much more likely to see “can’t”.

There are other possibilities but space and time also produce restrictions. Let me offer a few suggestions:
A) Get into the feeling of “can” before you leave for the market. Don’t wait to see how you’ll feel.
B) Aggressively seek new recipes and new forms of foods. The mistake commonly made is to eliminate the foods that are now bad for you, leaving a list that quickly feels boring and restrictive.
C) Try to stay on the edges of the market. The less you make eye contact with foods that aren’t good for you, the easier it will be. Each time you have to say “NO” to yourself is a little blow you must absorb.
D) You’re allergic to white foods.
E) Really pay attention to the pleasure you’ve created. Keep it in mind while you shop.